Monday Medical: The role of case managers

When someone ends up at the hospital with an unexpected illness or injury, the last thing they want to worry about is what their insurance will cover or what sort of care they'll need once they're discharged.

That's where case managers come in.

One of the lesser-known roles at hospitals, case managers are patient advocates, taking on tasks such as coordinating care needed after discharge, communicating with families and working with insurance companies. Yampa Valley Medical Center has at least two case managers available every weekday and one during weekends.

"Many patients don't know what case managers do," said Bonnie MacFarland, a case manager and nurse at YVMC. "Patients are happy to learn someone is helping with these logistics, like talking to their insurance company. It can be a huge stress when patients come in visualizing what their bill is going to be. But we help with that, while making sure they get the care they need."

Case managers work closely with insurance companies, as well as Medicare and Medicaid, to ensure patients have optimal use of their benefits.

And always, patient care is at the forefront of their minds.

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"First and foremost, I think of myself and all of our case managers as patient advocates, helping to ensure that a patient's hospital stay meets their needs," MacFarland said.

Case managers help coordinate care within the hospital, while also working to develop a safe and appropriate discharge plan.

"We start thinking about the discharge plan basically when people are admitted," MacFarland said. "Right away, we look at things like whether they're from in town or out of town, if they have resources and family close by or whether they might need home health or a rehabilitation stay."

If a patient has questions, MacFarland is happy to find answers.

"We'll talk with the appropriate people and send the patient information," she said. "The patient is worried, the spouse or family is stressed — but we're here to take that role on."

Case managers can help find pastoral care or connect a patient with mental health professionals. They can even make sure a patient's pets are looked after. They work with community resources, such LiftUp of Routt County, which may help a patient find emergency housing or get money for gas.

"We have terrific, caring people in our community," MacFarland said.

Case managers are trained to assist the crisis support team and may assist in the Emergency Room or with coordinating logistics, such as providing information about local transportation.

Sometimes, they reach out to patients before they're admitted: If someone is scheduled for a surgery or has a high-risk pregnancy, a case manager calls to be sure the patient knows what's going to happen during and after their stay.

"We try to put things together, even before a patient comes to the hospital," MacFarland said.

MacFarland is quick to point out that case managers are only one part of the entire healthcare team. Though their work is often behind the scenes, it's comforting to patients to know that they're there.

"When people know there's someone else looking at these things, it can help bring the anxiety and fear down," MacFarland said. "It takes a lot of time to coordinate everything. We're glad to help put all the puzzle pieces together."